Opinion on cause of neuropathy

Oct 17, 2002

In the last two weeks I have been experiencing neuropathy in my hands, forearms, feet and lower legs. I have been on meds (Combivir and Sustiva) for two years. In addition, I take 10 mg of Lipitor because my cholesterol continued to elevate significantly in the first year of the meds. I also take 180mg Allegra, 4 squirts of flonaise, and a multivitamine everyday. My HIV doctor said that my neuropathy could not be caused by my HIV meds and sent me to my primary care doctor. The primary care doctor said Combivir could cause this sensation sometimes, but deferred to the HIV doctor's opinion because she would know more. I will get a blood test for B12, THS, and folate levels. In the meantime, I am to take 100mg of B6 and 100mg of B12 a day to see if this helps. I am a bit concerned, since my CD4 level dropped last time from 545 to 493, but the viral load remained undetectable. The HIV doctor said this wasn't a significant drop. When I began meds a rise of 40 was significant (began with CD4 304 and viral load 224,000). In addition she ordered a CD4 and viral load in two months after the last test (November 1), and she had been testing every six months. I am wondering if I may be building up a toxicity to Combivir with the drop of the CD4 level and the neuropathy. But more than anything, I guess I seeking another opinion.

Response from Dr. Henry

The 3TC component of Combivir can rarely cause neuropathy. An evaluation by a neurologist is often helpful to pinpoint the type/cause of the neuropathy. HIV drug related neuropathy usually begins in the toes/feet with numbness/tingling (usually both feet). If it looks like HIV-drug related neuropathy is a possibility, several months switching off the 3TC (i.e. tenofovir or abacavir would be possible choices) may help sort that out. KH

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